What is Piles (Hemorrhoids), and Can It Be Cured?

Key takeaways:

• Piles is a medical condition that results from inflammation (swelling) of veins in the rectum and anus, causing pain, discomfort, and even bleeding.
• Some piles, mostly internal piles, show no symptoms. But when symptoms are present, an affected individual may experience pain and soreness around the anus, red blood in the stool, or after wiping the anus an itchy anus.
• Piles cannot typically be completely cured but can be treated and well-managed.  

Piles are common, but few are familiar with them because they are hardly discussed. Some who experience them have no idea what they are

Also, some people who experience it find it embarrassing to speak about their condition; hence, they fail to consult a healthcare professional. This isn’t the best decision, as piles, if left untreated, can lead to major complications. 

What are piles?

Piles, also known as hemorrhoids, are a medical condition that results from inflammation (swelling) and engorgement of veins (blood vessels) in the anus, causing pain, discomfort, and even bleeding in that area.

Piles are very common but have received little research attention. In the United States, it tops the list as the third highest reason for both outpatient and emergency hospital visits annually.

The exact mechanism for the pile's development is still poorly understood. However, growing evidence suggests that the weakness of the muscles and ligaments supporting the blood vessels may contribute to the condition.

As people age, they begin to experience a decrease in muscle tone, which also applies to the muscles of the anal region. This is why older people tend to suffer from this condition more often than younger people.

Piles are observed mostly in people aged between 45-65 years. Though rare, it can also be observed in people over 20.

Can piles be cured?

Piles can be cured by excisional hemorrhoidectomy (a surgical procedure to remove piles). However, before opting for surgery in severe cases, there are several measures your doctor can recommend to help alleviate the symptoms. 

These measures are simply healthy lifestyle changes, like drinking lots of water and increasing fiber intake. Your doctor can also prescribe medications like creams to soothe the area, corticosteroids, and even laxatives. 

However, the above measures mostly work for people with low-grade piles. In severe cases, your doctor will suggest a surgical intervention. 

Types and grades of piles

Piles have different types and grades, ranging from mild to severe, depending on the size, location, and symptoms left for your doctor to pinpoint and diagnose. 

Internal piles

Just as the name implies, internal piles result from having inflamed veins deep in the rectum (the upper part of the anus) above the dentate line (a line that divides the anal canal into upper and lower parts). 

Because of its hidden location, this type is not easily detectable and is usually without symptoms. Larger ones can, however, be associated with symptoms, 

Prolapsed piles

Prolapse is the bulging or falling out of a body part. So a prolapsed pile is an internal pile that bulges out of the anus, causing severe symptoms. Prolapsed piles can be graded depending on the extent of the prolapse. 

• Grade 1 piles: Piles of this grade are located internally and have no prolapse.
• Grade 2 piles: With grade 2 piles, the piles bulge out of the anus during a bowel movement and can withdraw back in on its own after each bowel movement.
• Grade 3 piles: Just like in grade 2 piles, the piles bulge out of the anus during a bowel movement, but, unlike in grade 2, would need to be pushed back by you carefully. 
• Grade 4 piles: In this case, prolapsed piles can’t withdraw back in on their own, nor can you push them back. Grade 4 piles are very fragile because, if left untreated by a doctor, they can result in strangulation of the piles. When this happens, the piles get squeezed, and the blood supply can be cut off, leading to severe pain and other complications. 

External piles

Unlike the internal pile, external piles are below the dentate line, can be seen and felt and are mostly without symptoms.

Thrombosed piles

Thrombosed is a word derived from “thrombosis,” which is the formation of a blood clot. So, in the case of thrombosed piles, blood clots form in the lumpy piles, which may be internal or external. Thrombosed piles could cause severe pain.

Symptoms of piles

Some piles, mostly internal piles without prolapse, are without symptoms and can go unnoticed throughout a lifetime.  However, when the symptoms are present, they can range from mild to severe, depending on the type and grade.

Mild symptoms

Mild symptoms of pile include: 

• Presence of bright red blood after wiping or in the stool (‘nicknamed splash in the pan’)
• A feeling of discomfort in the anus
• Itchy anus
• Soreness around the anus
• Being unable to feel empty even after having a bowel move 
• Mucus in stool

Severe symptoms

Pile can also cause severe symptoms like:

• Severe pain in the affected area
• Rectal bleeding
• Presence of large blood clots
• Fever
• Pus leaking from the piles
• Unexplained weight loss

The above symptoms can also indicate other conditions and may not necessarily mean you have piles. Do not panic when you notice them; see your doctor as soon as possible for an accurate diagnosis.

Risk factors of piles

Some factors can increase the risk of developing piles, including: 

• Prolonged sitting on the toilet seat 
• Straining so hard during a bowel movement 
• Chronic diarrhea or constipation
• Being overweight  
• Constant lifting of heavy objects 
• Anal intercourse
• Persistent cough or habitual vomiting
• Pregnancy due to pressure increase in the pelvic area 
• Lack of high-fiber diet 
• Dehydration 
• Old age 

Preventive measures for piles

While some of these risk factors can’t be helped, most of them can. Doing the following may help prevent pile development:

• Eat a high-fiber diet (e.g., vegetables, beans, avocado and bananas).
• Drink enough water.
• Make a bowel movement when necessary.
• Keep your weight in check. 
• Avoid constant lifting of heavy objects. 

Diagnosis of piles

Your healthcare provider can take different approaches when diagnosing your condition.

1. Your doctor will typically ask for your medical history. 
2. They may do a physical examination. This diagnosis requires your doctor to look at or feel the area around your anus for swelling, prolapsed piles, thrombosed piles, anal fissures (a small tear in the lining of the anus), and leakage of stool or mucus.
3. For internal hemorrhoids, procedures like anoscopy or proctosigmoidoscopy may be involved. These procedures involve using devices called anoscopes or proctoscopes to examine the inner surface of the rectum.

Management and treatment of piles

Piles can be treated and managed properly in the following ways;

Medical/conservative management

Medical management techniques for piles include the following.

• Piles can be well managed by leading a healthy lifestyle, such as staying hydrated, maintaining a healthy weight, and eating foods rich in fiber, such as bananas, oats, apples, beans, and potatoes. 
• Cold compression therapy to ease the pain and discomfort.
• Your doctor may prescribe corticosteroids and painkillers to ease pain and inflammation. 

Office therapy

Office therapy for pile may include the use of:

• Rubber band ligation: Here, a band is fastened around the piles so that it falls off.
• Sclerotherapy involves the shrinkage of piles by injecting a liquid into them.
• Electrotherapy: A gentle electric current is used to shrink the piles.

Definitive therapy

In some cases, your doctor may suggest surgery for the treatment of your piles, such as:

• Hemorrhoidectomy: In this case, the piles are cut out.
• Stapled hemorrhoidopexy: Here, the piles are stapled back into the anus.

Final words

Piles are common; in mild cases, your doctor can treat them through office therapies and medical/conservative management. In severe cases, they can be cured through surgical interventions. 

Although some piles show no symptoms, consult your doctor to make an accurate diagnosis when you notice the slightest symptom.